She did not use any illicit drugs and was not taking medications at the time of the examination. She smoked one to two cigarettes per day for a year during her mid teens, then stopped. Her family history was also negative for cardiovascular disease, including PAD. In addition, she also had no known personal or family history of hypertension, diabetes, hyperlipidemia, deep vein thrombosis, hypercoagulable state, Raynaud’s phenomenon, collagen vascular disease or other autoimmune disorders. She denied any history of chest pain, shortness of breath, lower extremity edema, trauma, radiation exposure, ergot use for migraine or regular bicycling. Since then, her claudication advanced insidiously, progressively limiting her exercise capacity and walking distance. She noted the onset of these symptoms at 16 years of age after running short distances. The cases of two patients who developed symptomatic PAD before 25 years of age are described, and the various causes and management options available for the treatment of early onset PAD patients are discussed.Ī 26-year-old woman presented with complaints of bilateral calf pain after walking one to two blocks that was relieved with approximately 5 min of rest. Management of this early presentation of PAD is unclear because most of the available information concerns treatment of patients 40 years of age or older. Reports of very early occurrence and management are rare, especially of onset before 25 years of age. Their diagnosis and treatment have to be comprehensive to prevent early morbidity and mortality. Patients with early-onset disease, also called premature PAD, have a particularly difficult course with early involvement of other major arterial beds such as the carotid and coronary arteries. Nevertheless, the diagnosis must be considered in any patient with exertional lower extremity symptoms. It is mostly prevalent in patients older than 50 years of age its occurrence in younger patients is rare. Peripheral arterial disease (PAD) is defined as an ankle-brachial index of less than 0.9.
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